Abstract
Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.
Highlights
Heart Failure/The Management in Bilateral Vocal Fold Immobility (1) early diuretic therapy results in early decongestion, defined by a decrease in B-type natriuretic peptide (BNP), (2) early diuretic therapy versus decongestion correlates with favorable biomarker changes, and (3) early diuretic therapy versus decongestion is associated with better clinical outcomes.[6]
Time to BNP decrease was defined as the day when BNP decreased by ≥ 30% compared with admission and the last BNP value was ≥ 30% lower than admission.[7,8,9,10]
Among AHF patients treated with intravenous diuretic therapy, time to diuretics was not correlated with time to BNP decrease, and earlier time to BNP decrease but not time to diuretics was associated with better biomarker trajectories
Summary
Heart Failure/The Management in Bilateral Vocal Fold Immobility (1) early diuretic therapy results in early decongestion, defined by a decrease in BNP, (2) early diuretic therapy versus decongestion correlates with favorable biomarker changes, and (3) early diuretic therapy versus decongestion is associated with better clinical outcomes.[6]. There was a stepwise increase in risk for the composite end point and mortality in patients with later timing of decrease or no decrease of BNP compared with BNP decrease at day 1 (Figure 4B and Table 3).
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